Ernesto Holguin, RN, BSN, CNN, dialysis clinical coordinator at Las Palmas Medical Center in El Paso, Texas, was saddened to see his elderly patient arrive for her dialysis appointment in 2003 with a foot infection caused by a diabetic ulcer.
“Diabetes had affected her eyesight and caused her to lose feeling in her feet,” says Holguin. “It was only when she smelled a foul odor emanating from her foot that she realized something was wrong.”
Wishing there was a tool that could assist diabetic patients in preventing foot ulcers from developing, Holguin decided to invent a device.
Holguin is one of many nurses across the country who have envisioned inventions they believe will help improve patient care. One of the earliest nurse inventors, Bessie Blount Griffin, an African American nurse, invented a feeding tube during World War II to help feed paralyzed veterans. Since then, many more nurses have tapped into their natural problem-solving skills to invent devices to improve the patient experience.
Ernesto Holguin, RN, BSN, CNN
For Holguin, that meant finding a way for patients to avoid diabetic foot ulcers or in the event they did develop a foot ulcer, to prevent it from becoming infected. The American Podiatric Medical Association (APMA) says that foot ulcers are one of the most common complications in patients with diabetes and if not treated properly, can lead to infections and in some cases, diabetes-related amputation. According to the APMA, foot ulcers occur in approximately 15% of diabetic patients and are commonly located on the bottom of the foot. Among patients who develop a foot ulcer, 6% will be hospitalized due to infection or ulcer-related complications, and 14–24% of patients with diabetes who develop a foot ulcer will require an amputation.
“The current protocol for prevention of diabetic foot ulcers involves patients checking their feet on a daily basis for cuts, cracks, blisters, and signs of an open wound,” Holguin says. “Patients who have trouble viewing the bottom of their feet are often told to stand over a mirror at home, but this can be difficult for patients who are overweight, arthritic, or elderly and don’t have good balance.”
Holguin envisioned a device that patients would use at home to prevent and effectively monitor their diabetic foot ulcers. The apparatus would inspect, dry, and take pictures of a patient’s feet and then send that information to their clinician.
His idea began to gain traction in 2007 when the first iPhone was released, and the idea of doing remote patient consults became a distinct possibility. In 2015, Holguin was invited to a workshop that the MakerNurse program was holding in Texas. Founded in 2013, MakerNurse works with nurses to bring their ideas for inventions to fruition, believing the best ideas for patient care are often developed by those on the front lines who work directly with patients.
“I told Anna Young and Jose Gomez-Marquez, the cofounders of MakerNurse, about my invention and they were very enthusiastic and encouraged me to build a prototype,” Holguin recalls. “Even though I’ve always liked to tinker, I never imagined I would one day design and build a device that could help my patients.”
Gomez-Marquez says MakerNurse launched in 2013 with support from the Robert Wood Johnson Foundation. MakerNurse provides the tools, platform, and training to help nurses like Holguin make the next generation of health technology. Two years ago, MakerNurse partnered with the University of Texas Medical Branch at Galveston to open their first MakerHealth Space in John Healy Hospital.
“Too often nurses have a great idea on how to but aren’t sure how to make it a reality,” says Gomez-Marquez. “We encourage nurses who have an idea for an invention to build a prototype and run with their idea.”
Working out of his garage in El Paso, Holguin recently finished the fourth prototype for his device. The first three he says were too large and cumbersome for patients to use. The U.S. Patent and Trademark Office recently certified Holguin’s patent, and is now working with a local medical incubator to turn his idea into a medical grade device.
“The next step is to have the device tested in clinical trials, and if successful, to submit it to the Food and Drug Administration (FDA) for approval,” Holguin explains. “I’ve talked with several doctors who believe my invention could be part of an important part of a diabetic patient’s treatment plan.”
In addition to making it easier for diabetic patients to monitor their feet for foot ulcers, Holguin believes his invention would reduce hospital readmissions. And more importantly, it could also help patients maintain a better quality of life.
“Some diabetics are only in their forties or fifties when an infected foot ulcer leads to amputation and disability,” says Holguin. “I’m confident this device can help diabetic patients to remain employed and live fulfilling lives.”
Making Your Idea Reality
Do you have an invention you think would improve patient care? Here are some tips on how to get started.
Conduct Due Diligence
It’s important to research whether there are any similar products in development, and also to decide whether you want to sell your idea to a company or to start your own business. Organizations such as the Small Business Administration can help you with these decisions.
Design a Prototype
Ideas are great, but you need to have something tangible to demonstrate how your invention works. MakerNurse can help nurses learn how to sketch and design a prototype and test out their ideas.
Seek out Support
MakerNurse has MakerHealth Spaces across the country that provides nurses with direct access to tools, materials, and expertise to build prototypes and test their ideas. Interested hospitals can host a MakerNurse workshop or invest in a MakerHealth program for their hospital. Visit MakerNurse.com to learn more.
Additionally, companies like Edison National Medical lend their expertise to help inventors to make their ideas a reality. The company says inventors will never pay more than $25 so it’s low-risk.
Consider a Patent
After you’ve developed a prototype for your idea, consider getting a patent to protect your invention. Visit the U.S. Patent and Trademark Office.
Nurses as Makers
Roxanna Reyna, BSN, RNC-NIC, WCC
Roxanna Reyna, BSN, RNC-NIC, WCC, a wound care coordinator at Driscoll Children’s Hospital in Corpus Christi, Texas, calls herself “MacGyver Nurse.” True to her moniker, she invented a unique skin and wound dressing for infants with abdominal wall defects.
Reyna’s workplace, Driscoll Children’s Hospital, was one of five “expedition sites” initially launched at hospitals in California, New York, and Texas, by MakerNurse.
Reyna got the idea to make a dressing for children born with omphalocele, a type of birth defect that leaves intestines protruding from the body and covered only by a thin layer of tissue. Surgery repairs the defect, but in the interim, the infant is at risk of infection.
“There weren’t any dressings or bandages made for kids that provided the same level of healing,” says Reyna. “So, I started experimenting with bandages, sponges, and tape.”
Reyna’s invention not only helped her colleague and young patients, but she was also invited to the White House in 2014 to meet President Obama and to take part in an event honoring “makers.”
Since Reyna’s product is tailored to a specific group of patients and there’s not enough demand for it to be manufactured on a large-scale basis, she did make directions on how to construct her dressing through MakerNurse.
A Path of Beauty
Monique Rodriguez was working as a labor and delivery nurse in Indiana when she decided to launch her own beauty company, Mielle Organics.
“While looking for natural solutions for my own hair challenges, I began creating products in my kitchen and blog about my hair journey on social media,” says Rodriguez. “I gained an audience and people began to
ask if they could purchase my concoctions. A light bulb went off and Mielle Organics was born.”
Rodriquez initially stayed in her nursing job to save money to fund the company.
“I strongly believe in speaking things into existence. I wrote my resignation letter in May and dated for November and was actually able to quit my job sooner,” she says.
Although she had little entrepreneurial experience when she started her company, Rodriguez did have drive and determination. In an effort to learn as much as she could, Rodriguez read books, listened to podcasts, and scoured the Internet to obtain as much information as possible.
“When I launched my business in 2014, natural hair products for black hair was an emerging market and I was attempting to stay on the cutting edge,” she says. “Today, the market is much more competitive, and although there’s room for all brands to succeed, we strive to be number one.”
Rodriguez, who worked as a nurse for nine years, says one of the biggest barriers she faced in launching her own business was not letting fear overcome her.
“It was very scary leaving my career as a RN, because of the fear of the unknown,” says Rodriguez. “I also wish that I had a business mentor or someone to talk with in the beginning.”
Rodriguez says her background in nursing also proved helpful in developing the Mielle Organics line.
“I understood the importance of using high quality ingredients that are effective for hair growth,” she says. “When we formulate our products, we don’t just focus on hair care, but also how healthy are the ingredients.”
Today, Rodriquez leads a corporate staff of 13 and her business is thriving. Mielle Organics are now sold at Sally Beauty, Target, and CVS locations.
An Invention Leads to a New Business
Lisa Vallino, RN, BSN
Lisa Vallino, RN, BSN, still remembers when she and her nurse colleagues would turn plastic cups into makeshift intravenous (IV) covers for their pediatric patients. Although it worked to prevent patients from accidentally dislodging their IVs, Vallino thought there had to be a better way.
“Nurses are inventors by nature,” says Vallino. “I looked at these IV cups we were using to keep our young patients from snagging and pulling out their IV tubing, and it occurred to me that someone should invent a pre-cut IV insertion site cover.”
Vallino mentioned the idea to her mother Betty Rozier, and the two worked to design their own version of an IV site protector. They started with a specimen cup and tweaked the dimensions into a prototype they called “IV House.”
“The first feedback we received from nurses was that the device was too big,” says Vallino. “We went back to the drawing board and made a smaller size, as well as providing ventilation so we weren’t providing a warm, dark, and moist environment under the IV House.”
She and her mom then worked with a plastics manufacturer to produce the product in bulk.
“The first attempt was a disaster,” explains Vallino. “The manufacturer delivered the IV House shipment to the hospital without labels and we also discovered the finished product was full of flaws.”
The experience taught Vallino to fully vet and test a prototype with a manufacturer before committing to the process. While continuing to work as a nurse, Vallino spent her off hours developing her invention.
“We started with the UltraDome for pediatric patients, a clear, plastic IV site protector designed to shield, secure, and stabilize the catheter hub and loop of tubing at an IV insertion site,” says Vallino. “Since then, we’ve invented a new and improved UltraDome that is used in hospitals around the world.”
Since her first invention, Vallino has gone on to develop 19 other products under the IV House name and to also work with other nurses to develop their inventions.
“Several years ago, a nurse friend had an idea for an invention that I bought,” says Vallino. “That idea resulted in the new TLC UltraSplint, featuring an ergonomic design and see-through openings. We found that with traditional arm boards there were injuries occurring that could be avoided.”
Vallino says she still hears from a lot of nurses who have ideas for inventions. Many just want to know if their idea is viable. After signing a nondisclosure agreement, Vallino offers feedback on the ideas, and for those that show promise, she encourages those nurses to find the right buyer.
“Our business is concentrating on working to create the most effective and highest quality products available to IV therapy patients,” says Vallino. “In addition to maintaining our current products, I have ideas for an additional five to six inventions I’d like to roll out in the near future.”
Over the last decade, there has been talk of an impending shortage of nurses. Even in light of the economic downturn, the soaring demand for more educated nurses is expected to continue as baby boomers age and health care coverage expands. For nurses who are entering or are in the field already, this demand presents an excellent opportunity to advance their careers and expand their knowledge.
So what is the logical next step? Often, it is to obtain an advanced degree. Once the decision to pursue higher education has been made, the next question is where to enroll. As online degree programs have increased in popularity over the last few years, many prospective students may wonder about the similarities and differences between online and traditional nursing programs. Before making your decision, consider what type of institution and program will best suit your needs and situation.
Benefits of an online education
Many nurses say the primary reason they chose an online program is because of the convenience and flexibility. Online learning offers students who are trying to balance a family, career, and other commitments the opportunity to earn a degree without sacrificing their other interests and obligations. An online nursing program may also offer a wider variety of degrees than a local university—if a local university is even an option. Especially in rural areas, the distance and time to travel to a brick-and-mortar institution may make this option impractical.
Another benefit of online learning is the asynchronous environment. In an asynchronous learning environment, students can participate at their convenience instead of being limited to participating at the designated location and the time when a class is offered. In the online format, students can generally post their homework and contribute to discussions when it works best for them. This is an especially important benefit to nurses who work shifts that potentially preclude them from attending traditional classes.
Some nurses believe that enrolling in an online program means losing out on the networking and interaction opportunities that occur in a traditional classroom. While it is true that actual face-to-face interaction is limited, nurses still have the opportunity to connect and network with other professionals online. The online setting also allows students to network with classmates and faculty from across the country and potentially around the world. As a result, nurses have the opportunity to hear about what’s happening beyond their local area, as well as benefit from the practical experience and knowledge shared by colleagues in other locations. The ability to connect with professionals from different practice settings and to share experiences and challenges is also cited as a unique feature of online learning. And other student resources, such as career advisement and even tech support, are typically as accessible and readily available via online universities as traditional.
While it may be the solution for some, online learning isn’t for everyone. There are students who want or need a traditional learning environment. For instance, an online classroom lacks the nonverbal cues that visual learners prefer. Some students simply need the face-to-face interaction. Many feel most comfortable having conversations in person and not over the phone or via an online discussion.
In addition, online and traditional nursing programs have different communication styles. On the job, nurses are taught to be succinct in their writing style because of the volume of required documentation in electronic records and because much of their work is done via checklists. Nurses who choose online education participate in a more intensive writing program than traditional education offers, since nearly all of the communication online occurs in written form. Prospective students should keep their personal communication style and preferred learning format in mind when selecting a program.
For both traditional and online nursing programs, practicum or clinical experience is required. However, practicum arrangements vary by degree program as well as by institution. Undergraduate practicums in face-to-face programs are usually arranged by the institution, while undergraduates in online programs typically propose the facility and preceptor. For graduate practicums, the trend for both online and face-to-face programs is for the student to propose their facility and preceptor.
No back row
Class participation is a very different dynamic in an online program versus a traditional program. In a traditional classroom, faculty members typically lecture, and grades are often based on exams and papers rather than on classroom participation. On the other hand, an online program places greater emphasis on participation: everyone participates in discussions by posting their thoughts—there is no back row.
The asynchronous online environment is an unexpected benefit for many students, because it allows students to think about what they want to say before they actually say it. Online students have time to reflect on the discussion, and they are actually more engaged. Traditional students who fear public speaking tend to stay silent in class, whereas an online setting can help build confidence in shy individuals or help those for whom English is a second language compose their thoughts before speaking.
Above all else, quality
Regardless of the delivery method, it is important that students find a quality nursing program. When researching which program or type of institution is best, one of the first things prospective students should check is the accreditation. The program should be accredited by either the National League for Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE). Additionally, the school should also have a Higher Learning Commission (HLC) accreditation if it offers doctoral programs, as Ph.D. programs are not NLNAC- or CCNE-accredited.
Another consideration when choosing a nursing program is to look at the level of faculty preparation and experience. Faculty credentials are important, and faculty members should be teaching in their areas of expertise—as established through both academic preparation and experience. Faculty members should be experts, and they should be certified in their areas of practice.
For an online nursing program in particular, it is important to see how long the institution has been in the business of teaching and offering classes online. Many schools are now offering classes online, but that doesn’t mean that their classes are designed for a truly online experience. To provide a high-quality online nursing program, it is necessary for the school to have expert instructional-design knowledge as well as the technology support that online students need.
Above all, prospective nursing students need to be diligent and research the institution. Talk to an enrollment advisor about the program and the various resources available. Also, reach out to faculty members and current students, as well as alumni who have gone through the program. Ask them questions about their experience, course content, and how the degree has helped them succeed. Prospective students can also check out benchmarks with the American Distance Education Consortium (ADEC), the American Federation of Teachers (AFT), and the National Education Association (NEA) to see if the institution they are interested in enrolling in is meeting those benchmarks.
At the end of the day, there is no significant difference between student outcomes for traditional and online nursing programs. Both can provide a rewarding learning experience, but, ultimately, it is up to the student to determine which program and delivery method are best suited to his or her current situation and needs.
With over 2,000 nursing schools in the United States, it can be challenging to determine which nursing program will meet your specific needs. In addition to traditional nursing programs that meet on campus, there has been a significant increase in the number of accelerated and online nursing programs being offered across the country.
The American Association of Colleges of Nursing (AACN) says accelerated programs for non-nursing graduates have gained momentum as colleges work to meet the Institute of Medicine’s call to increase the proportion of nurses with baccalaureate degrees to 80% by 2020. According to AACN statistics, research has shown that lower mortality rates, fewer medication errors, and positive outcomes are all linked to nurses prepared at the baccalaureate and graduate degree levels.
“I believe the BSN should be the minimum requirement for entry to practice for all nurses,” says Monica McLemore, PhD, MPH, RN, an assistant professor of family health care nursing at the University of California, San Francisco. “Science moves too quickly for nurses not to have a broad set of skills that are included in the four-year degree. I also believe nurses need to advance their education and to plan for this advancement in the context of the rest of their lives.”
Choosing an Accelerated or Online Nursing Program
The Saint Louis University School of Nursing introduced the first accelerated BSN program in the country, says Teri A. Murray, PhD, APHN-BC, RN, FAAN, dean of the school of nursing. The 12-month program was launched in 1971 for students with a non-nursing bachelor’s degree who were interested in pursuing an RN license and a BSN degree. The university also offers a 21-month accelerated MSN program.
For those with a prior degree, accelerated nursing programs offer the fastest path to becoming a registered nurse with programs generally running 12 to 18 months long. The Saint Louis University RN-to-BSN program can be completed in three full semesters and also offers clinical experiences at top hospitals and a simulation laboratory.
“We need more baccalaureate-prepared nurses from diverse backgrounds,” says Murray. “The United States Department of Health and Human Services says there are approximately three million RNs living in the U.S. Of those, 16.8% identified as belonging to a racial and/or ethnic minority, which remains far removed from the 28% diversity of the general population.”
For registered nurses who are looking to earn their bachelor’s degrees, many colleges have begun offering RN-to-BSN programs. Oregon Health and Science University (OHSU) in Portland, Oregon, is one such college that offers an online RN-to-BSN program.
“Our online BS-RN program focuses on leadership, population-based community care, and evidence-based practice,” says Glenise McKenzie, PhD, RN, an associate professor and the RN-to-BSN program director at the OHSU School of Nursing. “In our Leadership courses, students learn how to analyze systems-level data and improve health care delivery through the development of a quality and/or process change project. In Population-Based Health, students focus on community and public health nursing, incorporating social, environmental, and cultural assessments into the care of a selected population in a non-acute care setting.”
McKenzie says the OHSU online program utilizes a variety of teaching and learning strategies throughout courses, including: voice-to-voice webinars; voice-over lectures; small online asynchronous and synchronous group discussions; online group projects and presentations; one in-person conference (two days with public health and community assessment focus, including a simulated cultural diversity experience); individual written assignments; online quizzes; and guided learning activities focused on application of health and wellness concepts.
Kamala Basak, RN, who works as nurse manager at the Tri-City Health Clinic in Fremont, California, is currently enrolled in an online RN-to-BSN program through Grand Canyon University in Phoenix, Arizona.
“In the RN-to-BSN program, I’ve learned how to lead a team instead of just managing my staff,” says Basak. “In addition, being able to study and research on my own helps me learn the material in a better way—and that is why I prefer learning online. In this program, even though we do not see our classmates, we still communicate and work together to complete our group projects.”
Going Beyond the Bachelor’s Degree
Elizabeth Florez, PhD, RN, assistant professor at the DePaul University School of Nursing in Chicago, Illinois, strongly encourages aspiring nurses not only to obtain their BSN, but also to continue on to get an advanced degree. Nurses with a graduate education provide direct patient care at an advanced level, conduct research, teach, impact public policy, lead health systems, and more.
“Many hospitals will now only hire BSN-prepared nurses or require diploma nurses already working in the hospital setting to go back to school to obtain a BSN,” Florez says.
Florez notes that aspiring nurses who already have a non-nursing bachelor’s degree can also apply to a generalist in nursing master’s program where they will obtain a master’s degree and they will be able to sit for the National Council Licensure Examination (NCLEX) board exam.
“Obtaining a master’s degree in nursing offers many additional benefits for advancement once the nurse has sufficient nursing experience,” Florez says.
And it’s never too late to go back to school to obtain an advanced nursing degree. McLemore went to nursing school right out of high school at the age of 17, but completed her PhD program at the age of 40.
“I wish I had entered graduate school sooner than I did [six years after completing my BSN],” she says. “I plan a long research, teaching, and clinical career.”
Murray also completed her doctorate program just as she was approaching her 40th birthday.
“Had I known the benefits of doctoral education, I would have started immediately after completing my BSN,” Murray says. “This would have given me a longer time to make strong contributions to advancing the field of nursing. Nursing is a wonderful field, and there are many expanded opportunities that come with graduate education at the MSN, DNP, or PhD level.”
Florez says there is a great need for more nursing professors overall, but especially nursing professors from minority backgrounds.
“Master’s degree students are encouraged to seek clinical instructor positions once they obtain sufficient nursing experience, and they are also encouraged to continue their advanced education to the doctorate in nursing practice or PhD level to obtain a faculty position,” says Florez. “Currently, DePaul University has a Bridges to PhD program, which is a National Institutes of Health funded grant program affiliated with the University of Illinois at Chicago. That program is meant to increase the number of minority faculty with a PhD.”
Eligible DePaul nursing students enrolled in the master’s entry to nursing practice program are able to apply to the Bridges to PhD program, and qualified students will then be provided many resources and support to ensure they are adequately prepared for the PhD program.
Making Nursing School Affordable
While the cost of an education can be a barrier for many nurses, experts say there are many scholarships and financial incentives available that can help to make nursing school more affordable.
Students should never assume they can’t afford a specific nursing school, says Aara Amidi-Nouri, PhD, RN, associate professor, chair of the BSN program, and director of diversity at Samuel Merritt University School of Nursing in Oakland, California.
“I see far too many high school students who incorrectly assume they can’t attend private nursing schools, when they could easily qualify for financial aid,” says Amidi-Nouri. “My recommendation is for students to widen the net and examine their options before committing to a particular program.”
And although the Free Application for Federal Student Aid (FAFSA) is available January 1, many students don’t apply until the last minute. This doesn’t give them enough time to complete the process, and can also prevent them from obtaining certain grants and scholarships offered on a first-come, first-served basis. Other students don’t know financial aid is an option, or believe they won’t qualify because of their income.
“Students should always apply for FAFSA to receive financial aid but also look into scholarship opportunities,” says Florez. “Some colleges or universities may offer internal scholarships; however, students should also be encouraged to seek outside scholarships, such as through minority nursing associations, professional nursing organizations, and state/national scholarship programs.”
In addition, Florez notes that many nursing organizations will allow students to become student members, thus offering them additional mentorship and financial support.
“There is even more financial assistance available for minority students seeking a PhD in nursing through grants, fellowships, and teaching/research assistant positions,” says Florez. “Once students complete their nursing program and begin working in the field, they may qualify for loan repayment programs such as the one offered through the Health Resources and Services Administration that pay back a portion of nursing loan debt for registered nurses working in hospitals and clinics that care for underserved, underinsured, and uninsured populations.”
Many nursing schools, including the St. Louis University School of Nursing, are making a concentrated effort to attract more minority and male nursing students.
“For the past six years, we’ve been the proud recipient of the Robert Wood Johnson Foundation New Careers in Nursing Scholarship,” Murray says. “This scholarship program is directed toward underrepresented students, which include males and minorities, for entry into the accelerated program in an effort to diversify the nursing profession.”
What to Look For in a Nursing School
Amidi-Nouri says choosing a nursing school depends a lot on a student’s goals and where they are in the process. A high school student may choose a different program than a paraprofessional (CNA, LVN) who is already working in the field.
“If you’re looking at an RN program, such as an ADN, check to see if the school has a joint program with a BSN program, or whether you will have to reapply to an RN-BSN program to obtain your BSN,” suggests Amidi-Nouri.
Amidi-Nouri encourages prospective students to consider the following when choosing a nursing program:
• What is the nursing school’s graduation rate?
• What is the NCLEX pass rate?
• What is the local reputation of the school?
• What commitment does the school make to diversity (e.g., mission statement, vision statement, course offerings, diversity office)?
• What are the values of the school of nursing and of the university?
• What kind of academic support is available? Tutoring? Mentoring?
• How long is the program and what are the different pathways to get there?
• Are the faculty bios on the website? Do you see that faculty are diverse and/or have interest in diversity and health disparities?
• Is there a part-time option? If so, how long will that take?
• Are there information sessions, either live or virtual, that can tell you more about the program?
“Technology is important and students should seek programs that have vast resources in terms of a skills lab,” says Mona Clayton, RN, BSN, an author and nurse from Lakewood, California, who completed nursing school as a single mother, and now encourages other single mothers to enter the nursing profession in her “Surviving the Journey” seminars. “Finding schools that are associated with “magnet” hospitals, accredited by the American Nurses Credentialing Center, is a plus.”
Magnet hospitals are recognized for having better nursing environments, promoting excellence in nursing practice, and providing high quality patient care.
“Use the Board of Registered Nursing website as a resource for finding schools with top-notch passage rates for the National Council Licensure Examination (NCLEX-RN) exams,” Clayton says. “I also encourage single parents and working students to seek out programs that are flexible and offer weekend and evening classes.”
Murray advises minority students to also seek institutions with a welcoming campus atmosphere and a mix of diverse individuals (e.g., faculty, students, and staff).
“Often when there are only a handful of diverse individuals, students voice concerns related to feelings of isolation, alienation, and loneliness,” Murray says. “The student should determine if the institution’s leadership supports a diverse and inclusive climate evidenced by proactive actions, policies, and services that support this belief.”
Students should also ensure the nursing school they choose to attend is accredited by the Commission on Collegiate Nursing Education or the National League for Nursing Accrediting Commission.
“Accreditation is important for making sure the nursing school has met the state requirements to be able to take the national board exam,” Murray says. “Minority students should select a nursing program that has additional support for students to be successful. The additional support might be in the form of a nursing student organization, mentor/mentee program, tutoring, open lab hours, success coaches, et cetera.”
Melissa Leung, RN, BSN, still remembers the day she encountered an elderly patient who was resisting her medication. The woman, a native of China, had balked when given her pills and a glass of cold water, and it was noted on her chart that she was “medically noncompliant.” Leung, who is fluent in Mandarin, gently spoke to the woman in her native language to determine why she was reluctant to take her medicine.
“Like many Chinese immigrants, she had been taught to drink hot water with meals,” says Leung, who works in the cardiac catheterization lab at Einstein Medical Center in Philadelphia. “In China, some people are taught to boil water before drinking it to remove germs, and others believe that drinking cold water is bad for the stomach.”
Leung noted on her patient’s chart that she preferred to take her medications with hot water. As a bilingual nurse, Leung was able not only to communicate with her patient in her native language, but also to provide culturally specific care by being sensitive and responsive to her patient’s cultural beliefs and traditions.
As immigration increases, the demand for bilingual and multilingual nurses continues to grow. According to the US Census, between 1980 and 2010, the number of people speaking a language other than English climbed 158%. In addition to English and Spanish, the 2011 Census showed there were six languages spoken at home by at least 1 million people: Chinese (2.9 million); Tagalog (1.6 million); Vietnamese (1.4 million); French (1.3 million); German (1.1 million); and Korean (1.1 million).
Hospitals across the country are seeing more patients with different language needs, cultural sensitivities, and religions. While interpreters are employed by many hospitals, bilingual and multilingual nurses provide another way of bridging the cultural gap.
Because factors such as language, unfamiliar customs, and misconceptions about health care can keep foreign residents from seeking medical care, bilingual nurses can help to ease a patient’s fears and even reduce barriers to clinical preventative care.
There are also professional benefits to learning another language: Some bilingual employees can earn more than their single-language colleagues.
Providing Culturally Sensitive Care
Jimmy Andres Reyes, RN, MSN, DNP, AGNP, of Cedar Rapids, Iowa, an instructor in advanced practice nursing with Kaplan University School of Nursing and the dean of nursing at Kirkwood Community College, says he was inspired to become a nurse after watching the work of his grandmother, who was a community health nurse in Santiago, Chile.
Five years ago, Reyes received a predoctoral scholarship award to study diabetes self-management in Latino older adults. Fluent in both Spanish and English, Reyes says that being bilingual allowed him to hold focus groups in Spanish that helped staff determine the stressors and barriers that prevented the patients from keeping their diabetes under control.
“We learned many of these older adults would simply nod and agree with their health care providers, even if they didn’t understand the instructions they were being given,” explains Reyes. “For them, it was simply easier to be cordial, but as a result, they weren’t learning the tools and information needed to manage their diabetes.”
Reyes and his colleagues were able to take the information gleaned in talking with Latino immigrants and to pilot several programs. The information they gathered was not only translated into Spanish, but also designed to be culturally sensitive and relevant.
Reyes also believes that nurses can learn about different cultures through medical missions and studying abroad. He recently accompanied a group of nursing students to Costa Rica and plans to take another group to Ecuador later this year.
“Traveling to Costa Rica changed the world view of all of our students, and even those who didn’t speak Spanish returned to the US with a better understanding of the health care barriers and challenges that many immigrants face,” says Reyes.
As a bilingual nurse educator, Reyes believes his job in providing culturally sensitive care isn’t to change the beliefs of his patients, but rather to provide them with all of the facts they need to manage their condition.
“We have recently started working on a cancer prevention project with Latino and Burmese immigrants,” he explains. “Most of the people we spoke with weren’t aware of the new HPV vaccine that can be given to teens to protect them against the virus that causes cervical cancer and some other forms of cancer. We’re not mandating they vaccinate their kids, but rather providing them with the information to make an informed decision.”
Reyes is a member of several professional organizations, including the National League for Nursing, the American Academy of Nurse Practitioners, the Gamma Chapter of Sigma Theta Tau International, and the National Association of Hispanic Nurses, to name a few. He encourages nurses to become involved in organizations and associations that can give them a better understanding of the diverse patients they serve, as well as to consider learning a second language to better communicate with their patient population.
“We have nurses who are not Latino or Burmese who have picked up on the languages, and the patients just beam when they hear the nurse interacting with them in their native language,” says Reyes. “It not only shows they care; it’s also the first step in building trust.”
Addressing Patients’ Unique Cultural Beliefs and Concerns
Shency Varughese, MSN, RN, an immigrant nurse from India, works in the Inpatient Surgical Unit at the Cancer Treatment Centers of America, Midwestern Regional Medical Center, in Zion, Illinois. She has found that speaking a familiar language with patients helps earn their trust and respect.
“According to the nurse theorist Dr. Madeleine Leininger, nursing care must be customized to fit with the patient’s own cultural values, beliefs, traditions, practices, and lifestyle,” says Varughese. “I was able to put this into practice recently while caring for a patient who had a special request for a specific Indian tea that contained natural immunizers such as ginger and cardamom.”
Varughese notes the tea needed to be prepared in a special way and was very important to the patient. Although she acknowledges the act of preparing tea wasn’t earth shattering and could have been performed even with a language barrier, the act allowed her the chance to connect with the patient and provide culturally sensitive care.
“Our shared Hindi language allowed me to truly listen and understand his request and respect his needs,” explains Varughese. “I was able to understand how the preparation and drinking of the tea was an important part of this patient’s life.”
Varughese says being multilingual has also helped in her nursing career: “My peers know that they can count on me if a patient has a need or request. We have a translation service that our patients use to help communicate anything related to their medical needs; however, I am more than happy to step in and help with all non-medical patient requests.”
Nenette Ebalo, RN, has found that her ability to speak Tagalog provides an extra layer of comfort to the Filipino patients she sees in her job as service unit manager for the Head and Neck Surgery department at Kaiser Permanente’s Oakland Medical Center. In addition, Ebalo notes that in-person communication allows her to take cues from a patient’s body language that may be lost over the phone. It also allows for easier communication with elderly patients who may be hard of hearing.
“As a bilingual nurse, I don’t replace our medical center’s interpreting staff, but I am able to help patients who might prefer an in-person interaction with a nurse,” says Ebalo. “This can be helpful, especially for those who have complex medical conditions and may not understand the medical terminology.”
Ebalo remembers a recent case when she encountered an older couple waiting to see a speech pathologist. The wife told Ebalo she was concerned because her husband was suddenly having speech problems, and after speaking with Ebalo in Tagalog, they asked if she could accompany them to their appointment. After a consultation with the speech pathologist, Ebalo was able to explain to the wife that her husband’s condition was a side effect of the radiation he had been given.
“They were very appreciative of my help and returned later that week with Ensaymada, a traditional Filipino sweet bread to thank me,” says Ebalo.
In addition to her work at the hospital, Ebalo has worked on several medical missions and has found that her language skills prove beneficial when caring for patients abroad.
“I recently accompanied some of our physicians on a medical mission to the Philippines where I worked as a bedside nurse in the recovery room,” says Ebalo. “The doctors were repairing cleft lips and palates, and they relied on me to help them to understand both the language and the culture.”
Breaking Communication Barriers
Michelle Moore, BSN, RN, HN-BC, inpatient care manager at the Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Illinois, first learned American Sign Language (ASL) to communicate with her daughter who was born deaf. Since then, Moore has found that knowing ASL has also helped her in her job.
“Deaf individuals are unique in that they cannot use a language line to talk with the hearing community,” says Moore. “Deaf people use electronic devices—mostly smartphones now—to communicate with the hearing world. Years ago, I was part of the committee that helped bring devices [such as TTY, the flashing door bell, and the bed alarm] to the hospital.”
In addition, Moore says that although she is not a certified ASL interpreter, she has had general conversations with deaf patients and their caregivers, which allows them to feel comfortable with a culture they are familiar with.
“Having the ability to speak with people in their common language is such a gift,” says Moore. “Years ago, we had a new patient who was deaf, and her interpreter was running late. I remember sitting in the lobby waiting with the patient and just carrying on a normal conversation with her. The patient felt comfortable that someone in a strange environment was available and familiar with her language.”
Moore notes that every time the patient would return to the hospital, she would ask to see her. “She often shared with me how grateful she was that I was with her on her very first visit and how it allowed her fear to decrease and put her mind at ease,” says Moore.
Becoming a Certified Medical Interpreter
While many bilingual nurses help patients in an unofficial capacity, some nurses are taking their translating skills to the next level and becoming certified medical interpreters. Having credentials provides documentation that nurses have the necessary skills required to translate or interpret professionally.
Yelena Tuerk, RN, BSN, MS, manager, patient care services, for the Rose D. and Joseph W. Lazinsky Neuroscience Center at Sinai Hospital in Baltimore, was born in Russia and is fluent in both Russian and English. After seeing a large influx of Russian patients at her medical center, Tuerk decided to become a certified medical interpreter in order to assist patients in a more official capacity.
Tuerk enrolled in the three-day Qualified Bilingual Staff program offered through the Maryland Healthcare Education Institute, which covered many areas including legal requirements, cultural competency, and privacy laws.
“The course taught the specific way to translate for nurses to ensure that we provide high quality care,” explains Tuerk. “The training goes beyond just speaking a second language; it also covers how to best convey medical terminology, and how to serve as the voice of the patient to ensure that all of their questions are addressed.”
Despite advances in recent years relating to cancer prevention, detection, and treatment, many minority groups in the United States continue to bear a greater cancer burden than whites.
According to the National Cancer Institute’s Center to Reduce Cancer Health Disparities, while one in three Americans will develop some form of cancer, it continues to be the number one cause of death for many minorities in the United States. Nationwide, African Americans have a higher rate of death from cancer than Caucasians, and cancer has surpassed heart disease to become the leading cause of death among Hispanics and Asian Americans in the United States.
While the statistics are sobering, researchers say minority nurses can play an important role in working to reduce cancer disparities in their communities.
“Nurses are at the forefront of care and can have a major impact in eradicating cancer disparities by educating patients about the importance of cancer screenings, early detection, and access to care,” says Kimlin Ashing-Giwa, PhD, professor and director of the City of Hope’s Center of Community Alliance for Research and Education in Duarte, California. Ashing-Giwa’s work focuses on addressing the disparities in treatment and outcomes between patients with different access and cultural approaches to medicine.
How Breast Cancer Affects African American and Latina Women
“Although African American women are less likely than white women to be diagnosed with breast cancer, they are more likely to be diagnosed at a later stage and to die of their disease,” says Ashing-Giwa. “Despite the decline in overall breast cancer death rates in the past 20 years, black women continue to have higher death rates.”
A 2012 report from the Centers for Disease Control and Prevention (CDC) says that mammography may be used less frequently among black women than white women. It’s also more common for a longer amount of time to pass between mammograms for black women. Additionally, Ashing-Giwa notes that African American women commonly have subtypes of tumors that are harder to treat, especially an inflammatory form called triple negative breast cancer.
The CDC report also stresses the importance of educating women about the preventive benefits and coverage provided by the Affordable Care Act, including coverage of mammograms without co-pays in many health plans and, beginning in 2014, expanded access to health insurance coverage for 30 million previously uninsured Americans.
“Additionally, a woman’s best overall preventative health strategy is to reduce her known risk factors for breast cancer as much as possible by avoiding weight gain and obesity, engaging in regular physical activity, and minimizing alcohol intake,” says Ashing-Giwa, who encourages nurses to talk to patients about their risk of breast cancer and the importance of getting mammograms and doing breast self-exams.
If women can’t afford a mammogram, there are many free resources available that nurses can recommend to patients (see sidebar). In addition, black women are less likely to get prompt follow-up care when their mammogram shows that something is abnormal. Waiting longer for follow-up care can lead to cancerous tumors that are larger and harder to treat.
Follow-up care after mammograms is also a problem for Latinas. “While Latinas have lower incidences of breast cancer than white or African American women, breast cancer is the leading cause of cancer death for Latinas,” Ashing-Giwa says.
A March 2013 study conducted at the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio and published in SpringerPlus found that it took Latinas 33 days longer to reach definitive diagnosis of breast cancer than non-Hispanic white women. Researchers found that Latinas with abnormal mammograms benefitted significantly from the help of trained professionals called “patient navigators,” who were trained in providing culturally sensitive support. Patient navigators were also helpful in providing transportation, language, and childcare solutions.
“We need to move toward more prevention, screening, treatment, and follow-up that speaks to people in a language they understand,” says Ashing-Giwa.
Despite Being Preventable, Disparities Still Exist With Cervical Cancer
Also of concern are the large differences in rates of new cases and deaths from cervical cancer among African American and Latina women. “Latina women have the highest rates of cervical cancer, followed by African American women,” says Ashing-Giwa. “This is troubling because most cases of cervical cancer are largely preventable and treatable with regular Pap tests and follow-up.”
Mortality rates are also higher for women over 50.
“Many women believe that since they are single and not sexually active, they don’t need a Pap test,” Ashing-Giwa says. While stressing the need for older women to get regular Pap tests, she notes it’s also important for nurses to encourage younger women to get the human papillomavirus (HPV) vaccine and to use condoms. HPV infection is the leading cause of most cervical cancers.
“Cervical cancer should have been eradicated 30 years ago with the invention of the Pap test,” argues Ashing-Giwa. “Most women who are diagnosed with cervical cancer today are those who have never been screened for it.”
Minorities Less Likely to Get Screened for Colon Cancer
A 2012 study conducted at the Center for Health Policy at the University of Nebraska Medical Center College of Public Health and published in the public health journal, Health Affairs, found that minorities are less likely to be screened for colon cancer. The data revealed that 42% of Caucasians were screened for colorectal cancer, compared with 36% of African Americans, 31% of Asian and Native Americans, and 28% of Hispanics.
“The death rate for colon cancer has increased among African Americans and Hispanic people despite it being one of the most preventable forms of cancer, and if caught early, one of the most curable,” says Durado Brooks, MD, MPH, director of prostate and colorectal cancers for the American Cancer Society.
“Although many people of color are aware of colon cancer, they don’t always see how it applies to them,” says Brooks. “If they don’t have a family history of the disease or have symptoms, such as blood in their stools, they often don’t see the need to be screened.”
Only 10% of colon cancer cases are tied to family history, and by the time warning signs are apparent, the cancer has often progressed to an advanced stage where it’s harder to treat. And while it is currently recommended that regular colon screenings begin at the age of 50, it’s recommended that screenings for minorities begin at 45 since many colorectal cancers have been caught in African Americans and Hispanics at younger ages.
“Many people are unaware of the benefits of colorectal screenings,” says Brooks. “There’s the perception that cancer is a death sentence, yet up to 90% of colon cancer cases are preventable with screening.”
Brooks praises Kaiser Permanente for being proactive about screening its health plan members for colorectal cancer. “Rather than waiting for people to ask to be tested, Kaiser Permanente sends out fecal immunochemical testing kits, a type of fecal occult blood test, in the mail to their members who are 50 and older,” Brooks says. “Not all health care providers are as proactive with their approach.”
And while colonoscopies are still considered the gold standard for detecting colorectal cancer, they also require rigorous preparation—a point that prevents many people from getting tested. In an effort to increase testing for colon cancer, Brooks notes that it’s important to let patients know they have choices and that there are other screening options available.
A study published in the April 9, 2012 issue of Archives of Internal Medicine confirmed this by noting that patients were less compliant with screening for colorectal cancer when colonoscopy was the only option offered. Yet when patients were given a choice between a colonoscopy and fecal occult blood testing, 69% completed one of the two exams.
Latino Men at High Risk of Prostate Cancer
According to the American Cancer Society, prostate cancer is the most commonly diagnosed form of cancer among Latino men, and they are also the most likely to be diagnosed with later-stages of the disease.
A new study conducted by researchers at the University of California—Los Angeles (UCLA) and published in the March 2013 issue of Qualitative Health Research concluded that a combination of financial, cultural, and communication barriers play a role in preventing Latino men from accessing the care and treatment they need.
“These obstacles require a new focus on not only adequate health care coverage, but also on the array of hurdles that limit patient access,” says Sally L. Maliski, PhD, RN, FAAN, associate dean for academic affairs at the UCLA School of Nursing and senior author of the study.
Maliski cites inability to afford medical insurance, difficulty understanding insurance policies, a lack of health literacy among the men, and their limited proficiency in English as barriers throughout the entire prostate cancer-care process.
“Our findings made it clear that we need a system where not only is care affordable, but where we use a multi-faceted approach to improve access, increase health literacy, and greatly improve care coordination,” says Maliski.
Focusing on Cancer Disparities in the Asian Community
“The cancer burden in the Asian American community is unique because cancer has been the leading cause of death among Asian Americans for the past 13 years,” saysMoon Chen, Jr., PhD, MPH, principal investigator for the National Center for Reducing Asian American Cancer Health Disparities headquartered at the University of California-Davis Cancer Center. Chen adds that hepatitis B induced-liver cancer is the greatest cancer health disparity for Asian Americans.
“All Asian American immigrants and their children should be screened for hepatitis B to lead to earlier detection,” Chen says. “And Asian Americans who do not have hepatitis B immunity should also get the hepatitis B vaccine, [which is] the best way to stop the spread of hepatitis B.”
Chen and his colleagues have received a federal grant to increase screening for hepatitis B. Since December of last year, screening events have been held in Northern California at Asian health clinics, local churches, temples, health fairs, and community organizations.
Many Asian Americans don’t get regular cancer screenings, which also adds to poor cancer outcomes. “Until they have symptoms, many Asian Americans aren’t really concerned about cancer and don’t think screening is necessary,” Chen says. “Vietnamese women have the highest rates of cervical cancer, which can be detected and treated early through Pap smears.”
Chen says cigarette smoking is also a big problem among Asian American immigrants and that they are the racial group least likely to be counseled on smoking cessation.
“Smoking is the leading cause of death worldwide and it’s a preventable risk factor,” Chen says. “It’s a complicated message and often language can be a barrier. There’s a great need for smoking cessation programs that are culturally tailored to Asian populations, both in language and intent.”
Stomach cancer is also prevalent in Asian Americans and Chen attributes this to chronic infection with Helicobacter pylori bacteria, which is common in developing countries. In Koreans, diet is also to blame, specifically foods that are preserved with nitrates and nitrites, such as kimchi.
Since prevention and early detection are key components of cancer control, Chen recommends that nurses who work with different Asian American populations either learn the specific language of their demographics, or have cancer education materials readily available in different languages such as Vietnamese, Korean, Mandarin, and Tagalog.
“Nurses who can accommodate differences in language fluency, dietary practices, and cultural beliefs can help to remove some of the barriers that exist in screening and treating minority patients,” Chen says. “Nurses who have this expertise are often the bridge between health care systems and minority communities.”